COVID Transmissions for 11-15-2021
A lockdown for the unvaccinated
Greetings from an undisclosed location in my apartment. Welcome to COVID Transmissions.
It has been 729 days since the first documented human case of COVID-19. In 729, the Kanhave Canal across the island of Samsø was completed in Denmark. This relatively short canal was one of the most complicated engineering projects completed in Europe in the Early Middle Ages.
Today, I discuss a lockdown of the unvaccinated in Austria, and also share a fantastic animation showing how mRNA vaccines work against COVID-19.
Let’s have a good week.
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Now, let’s talk COVID.
Austria initiates a lockdown of the unvaccinated
The country of Austria, like many others in Central and Eastern Europe, is experiencing another surge of COVID-19. I am concerned that the same may happen here in the US, but right now it is Europe that needs the spotlight. It has again become the region that is the most affected by COVID-19.
To fight this surge, Austria has innovated on the concept of lockdown, instituting one that is targeted to the members of their population who are both most at risk of COVID-19 and also most likely to spread it: unvaccinated people. You can read more about that here: https://www.bbc.com/news/world-europe-59283128
This may seem unfair, and I am sure it will be controversial. However, I am reminded of the fact that earlier in the pandemic, anti-lockdown and anti-masks activists (many of whom have upgraded themselves to anti-vaccination rhetoric) claimed widely that we could control the pandemic by just isolating those who are at the greatest risk.
The most famous of these is the Great Barrington Declaration, a document that ignored clear scientific evidence about the contagiousness and dangers of COVID-19 in order to advocate for allowing those at apparent low risk to avoid lockdowns and mask-wearing.1 The thing is, at the time that the Declaration was written, we had no meaningful way to predict the risk profile for an individual, and plenty of people with no apparent risk factors were still dying or becoming disabled from the virus. The Declaration was uninformed and it was callous. But it did say this:
The most compassionate approach that balances the risks and benefits of reaching herd immunity, is to allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk. We call this Focused Protection.
Adopting measures to protect the vulnerable should be the central aim of public health responses to COVID-19. By way of example, nursing homes should use staff with acquired immunity and perform frequent testing of other staff and all visitors. Staff rotation should be minimized. Retired people living at home should have groceries and other essentials delivered to their home. When possible, they should meet family members outside rather than inside. A comprehensive and detailed list of measures, including approaches to multi-generational households, can be implemented, and is well within the scope and capability of public health professionals.
This couches it in seemingly compassionate terms, but make no mistake of it: the goal of this was to isolate older and sick individuals in their homes under the misimpression that this would somehow be just as effective at disease control as wearing masks and engaging in population-wide measures. As wrong as the philosophy was, it also suggested a precedent for the isolation of people who are most at risk.
Now that vaccines are available, we actually do have a good way to predict whether or not someone will experience severe COVID-19 and whether they will die of it—we can check if they are vaccinated. To isolate the unvaccinated is to fulfill the principle of “Focused Protection” laid out in the Declaration.
I am not saying this because I agree with this sort of approach, but I will get to my personal opinion on the approach in a moment. I’m sharing this because I expect the same political entities that created the Declaration to be hotly critical of the Austrian policy. I wish to point out only that it is the exact policy for which they advocated earlier in the pandemic. The reason for any forthcoming objections will simply be because their suggested principle no longer benefits them at the expense of others, and instead now inconveniences them above others. That difference emphasizes that this never came from any place of compassion whatsoever.
For example, Jay Bhattacharya and Martin Kuldorff, original signatories, have already come out against “vaccine passports” (a new term for a longstanding aspect of typical health screenings before travel or immigration), which would isolate the unvaccinated while allowing the vaccinated to return to normal life. These sound like Focused Protection to me, but apparently to these Declaration authors, Focused Protection is only appropriate when it restricts vulnerable populations who have no choice in their circumstances, like the elderly or the disabled. To them, it is not for use to protect society from the unvaccinated, who made a conscious choice not to protect themselves. The obvious hypocrisy is…well, frankly, it’s pathetic. The point of the Declaration was never to protect anyone. It was to further a callous and ghoulish agenda that put productivity and the economy ahead of individual survival and wellbeing.
Let’s return to Austria’s move, for a moment, however. I am not sure that I agree with it in a vacuum. As a lone policy, I am not sure it will quickly blunt the spread of COVID-19.
In combination with other policies, I think it can work as a temporary measure. It might make sense to adopt this approach in a country where the vaccination campaign has followed certain specific principles, requiring 2 doses of vaccine for patients who received adenovirus-based vaccines spaced out by between 2 and 6 months, or 3 doses of any mRNA vaccine, spaced out by 1 month and then 6 months, or 1 dose of an adenovirus-based vaccine followed by a booster with an mRNA vaccine between 2 and 6 months later. These multi-dose booster schedules appear to substantially reduce the chances of a vaccinated person transmitting the virus, making isolation of the unvaccinated a prudent policy towards disease control.
Without that, I think that Austria’s policy will have to be in place for a long time for a surge to be controlled. Without those additional doses, the virus does not spread freely among the vaccinated, but it still does spread at a level that allows the outbreak to expand. The vaccine schedules that I have written above are suggested under the advice of an immunologist friend who I heard discussing this, with some slight personal modifications. I think if those were required alongside the Austrian policy, the combination could, relatively quickly, get their outbreak back under control.
This is just my opinion, however. No country has tested this approach. I will keep a close eye on Austria to see how things progress there following their new move. If it works out well, this may be the shape of more policies to come.
Incredible visualization of how an mRNA vaccine yields immunity against SARS-CoV-2
This video has been making the rounds in various circles, and it’s really awesome:
There are so many concepts here that are hard to explain in words—neutralizing antibodies, for one—that just make a ton of visual sense. A big part of biology is developing ways to talk about, and visualize, processes that we can’t actually see. Experimental logic needs to translate into a sort of thinking that looks like the above, and being able to create videos like this requires the work of thousands of scientists who are able to imagine each step of what you see here in their own minds from just simple experimental data. What you see there is the product of decades of the scientific enterprise turning the concept of novel disease from the capricious act of unknowable spirits into the understandable, and more importantly combatable, molecular action of a virus.
I recognize that the above is cut off a little bit. You can find a full version at the YouTube channel of the Vaccine Makers Project, here: https://www.youtube.com/c/VaccineMakersProject
They have a lot of other interesting videos that are worth checking out.
What am I doing to cope with the pandemic? This:
Boosted!
On Friday, I went to the American Museum of Natural History to get my booster dose for my mRNA COVID-19 vaccine series. My first two doses were Pfizer’s COMIRNATY vaccine, containing 30 micrograms of spike mRNA, given 3 weeks apart per the approved schedule for that vaccine at the time. Based on subsequent scientific data I have seen, I expected that I would be able to both tolerate as well as benefit from a booster vaccination with Moderna’s booster product, SPIKEVAX. SPIKEVAX boosters contain 50 micrograms of mRNA coding for the spike protein, more than COMIRNATY, but less than the first- and second- dose version of SPIKEVAX.
I expected that this slightly higher dose would help generate a higher level of neutralizing antibodies, since I have seen (and shared here) data to that effect.
I was modestly concerned about the possibility of myocarditis. It is still extremely rare to have this adverse event, but I did ask that the provider aspirate slightly before giving the vaccine. This was based on my thinking that it is possible myocarditis is more frequent with accidental intravenous administration of the vaccine, something which aspiration can detect and prevent. I’ve discussed the scientific evidence for this thinking before in the newsletter; I am not saying that I believe this thinking to be scientific fact, but I did want to see if they would do it.
At the site that I visited, they were not willing to do this as they had to adhere to a defined protocol for vaccination. This was not a deal-breaker for me. I monitored my injection site for unexpected bleeding, and I had minimal bleeding, which is relatively consistent with an intramuscular rather than intravenous injection. I have had no myocarditis symptoms following booster vaccination, either. In fact, yesterday, I ran 5 miles at a pace that was sufficient to elevate my heart rate into the 160-170 bpm range. I was fine throughout.
After the vaccination, I experienced mild adverse effects that were easily managed at home. I was more tired than after either of my Pfizer doses, and that’s why I went on a Friday—I used Saturday to sleep. I also was more sore in the injected arm. Neither of these things were serious, and both resolved to basically undetectable levels by Sunday. At this point my arm is a little sore if I rub the injection site. Per the old joke, since “it hurts when I go like this,” I can manage that by not doing the thing that hurts. I’m sure by tomorrow I’ll feel entirely fine.
In fact, I already feel pretty excellent, because I expect that this booster vaccination is making me pretty impervious to COVID-19. I’m not sure exactly how long that will last, but based on my understanding of the immune system, generally, repeated exposure leads to longer maintenance of high antibody levels each time. I feel pretty confident that I’ll be better protected for a while. I’m interested to see what we learn about durability of protection from others who have gotten boosted, as I have been.
In the past, I was opposed to booster vaccination because I felt that it was better to focus on vaccinating the unvaccinated. With the Biden Administration implementing a vaccine mandate for many employers, and vaccination rates on the rise nationally as well as in my state, I no longer see these options as mutually exclusive. Furthermore, I obtained a vaccine formulation that is only used for boosting; in other words, I was not taking a dose that could have been used for any unvaccinated person. This was another part of my motivation to seek out the Moderna booster. Finally, I have seen convincing data that a booster makes me much less likely to be able to get infected with SARS-CoV-2 at all, taking me off the table entirely as a pawn in the continued spread of the virus. I therefore see a clearly positive risk-benefit ratio for this; I am not making anyone less likely to be vaccinated, and I believe I am improving the degree to which I protect others from COVID-19. So, I got the booster.
After finishing my booster vaccination, I was allowed to move to the other side of the whale to be monitored for 15 minutes. I think of this side of the whale as the “vaccinated” side because it has a bandaid on its flipper:2
By choosing the museum as my vaccination site, I got a cool sticker with the whale on it as well as a free voucher for admission for myself and three others on a later date. Also, I became more protected from, and less likely to spread, COVID-19. There were really no downsides!
Reader Sam shared the following about the BBV152 vaccine that I discussed last issue, which has apparently also been submitted for a pediatric EUA in the US through a partner company:
Apparently, an EUA application has already been submitted for the Bharat vaccine for ages 2-18 (see: https://ir.ocugen.com/news-releases/news-release-details/ocugen-inc-announces-submission-emergency-use-authorization). The pediatric trial included just 526 kids. Not sure what they're thinking here -- I can't imagine the FDA supporting it.
I have to agree with Sam, I don’t think this has much chance of authorization. However, the vaccine technology here is more traditional than any of the other options available in the US, so maybe they thought it was worth a try. I guess we will see what happens, there. Probably the FDA will request additional data.
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No corrections since last issue.
See you all next time. And don’t forget to share the newsletter if you liked it.
Always,
JS
Please note: the Great Barrington Declaration generated an opposing document, the John Snow Memorandum, found at https://www.johnsnowmemo.com/, with the list of signatories found in full at https://www.johnsnowmemo.com/signatories.html. I am a signatory, under my full professional name rather than my pop-science pen name that I use for this newsletter.
The picture is from later, because the view of the bandaid from the floor was pretty bad. I walked around to the second level to be able to get this view instead.